Organization
UNIVERSITY CHILDREN'S KIDNEY SPECIALISTS, LLC
Active
Organization
UNIVERSITY CHILDREN'S KIDNEY SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERARD P. RABALAIS M.D. (CHAIRMAN)
(502) 852-8600
Entity
Organization
Contact information
Practice address
210 E GRAY STREET, STE. 1000, LOUISVILLE, KY 40202-3906
(502) 629-3972
(502) 629-3975
Mailing address
P.O. BOX 2469, LOUISVILLE, KY 40201-2469
(502) 852-8500
(502) 852-8556
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
—
—
2080P0210X
Pediatric Nephrology Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200432180
—
IN
05
—
65939571
—
KY
Enumeration date
01/05/2007
Last updated
05/14/2012
Update your record
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